Choudari C P, Rajgopal C, Palmer K R
GI Unit, Western General Hospital, Edinburgh.
Gut. 1994 Apr;35(4):464-6. doi: 10.1136/gut.35.4.464.
The underlying diagnosis and clinical course of 52 patients who presented with severe acute gastrointestinal haemorrhage while taking the anticoagulant warfarin is reviewed. A bleeding site was identified in 83% of cases, only slightly fewer than the 92% found in a control of group of 710 patients not taking warfarin who presented in the same four year period. The degree or duration of anticoagulation was unrelated to the frequency of establishing a diagnosis. The commonest diagnosis was peptic ulcer (25 cases) and endoscopic treatment by injection or heater probe was attempted in 23 of these. The outcome in this subgroup was compared with that in 50 closely matched control subjects who had similar risk factors for rebleeding from peptic ulcer. Permanent haemostasis was achieved in (91%) of the anticoagulated and in 92% of the control patients. There were no complications related to endoscopy. Patients who present with acute gastrointestinal haemorrhage while taking warfarin usually bleed from mucosal disease. They should be endoscoped after resuscitation and those with major bleeding from a peptic ulcer should be offered endoscopic treatment.
对52例在服用抗凝剂华法林期间出现严重急性胃肠道出血患者的潜在诊断和临床病程进行了回顾。83%的病例确定了出血部位，略少于同期就诊的710例未服用华法林的对照组患者中92%的比例。抗凝的程度或持续时间与确诊的频率无关。最常见的诊断是消化性溃疡（25例），其中23例尝试了注射或热探头内镜治疗。将该亚组的结果与50例有类似消化性溃疡再出血危险因素的密切匹配对照受试者的结果进行了比较。抗凝患者和对照患者中分别有91%和92%实现了永久性止血。未发生与内镜检查相关的并发症。服用华法林期间出现急性胃肠道出血的患者通常因黏膜疾病出血。复苏后应进行内镜检查，消化性溃疡大出血患者应接受内镜治疗。
